If you've been diagnosed with psoriasis, there's a good chance your dermatologist has prescribed a topical steroid treatment to help get it under control. Many doctors and patients find them to be a reliable short-term option for the dry, flaky patches of skin known as plaques. However, a recent story about a woman's adverse reaction to using topical steroids long-term may have those with psoriasis wondering if there might be alternative treatments that could help them avoid similar side effects, while also effectively relieving their symptoms.
"Steroids work by reducing inflammation in the skin," says New York City dermatologist Joshua Zeichner, explaining why it's such a common treatment for psoriasis. "However, long-term use can be associated with more harm than good. Steroids have been shown to cause thinning of the skin, stretch marks, and pimples." Plus, your skin can get used to the steroid, making it less effective over time; it's a phenomenon called tachyphylaxis, a condition that can lead to significant redness and inflammation.
Although some topical steroids have been approved by the Food and Drug Administration for use up to six months, generally speaking, experts warn that topical steroids should not be used for more than two weeks in a row. But if the risk of side-effects has you looking for an entirely different treatment option, there are several alternatives to topical steroids when it comes to treating psoriasis.
1. Topical Vitamin D
According to Zeichner, abnormal cell turnover leads to the white, flaky plaques that are characteristic of psoriasis. "Topical vitamin D creams are thought to help normalize cell turnover in psoriasis," he says. Therefore, topical vitamin D compounds are a common treatment for psoriasis, either used alongside topical steroids or instead of them.
There are a number of over-the-counter lotions and ointments that contain vitamin D, such as Now Vitamin D-3 Cream. However, Zeichner recommends speaking to your dermatologist to ensure you find a strong-enough formula. "We typically prescribe vitamin D creams that have proven skin penetration and effectiveness in treating psoriasis," he says.
"UV light is generally a no-no in dermatology since we know that too much can be associated with the development of skin cancer and melanoma. However, it has an anti-inflammatory effect in psoriatic skin and is a very useful option for reducing skin disease and symptoms," Tsippora Shainhouse, a dermatologist in Long Beach, California, told Allure last year. Your dermatologist may offer in-office phototherapy treatments, but at-home treatments are also starting to gain popularity, thanks to celebrity psoriasis sufferers who've used them.
Kim Kardashian West has described phototherapy as "life-changing" in regard to her years-long battle with psoriasis. She's an especially big fan of an at-home device called the Clarify Home Light Therapy System. But just because you can use this ultraviolet-light gadget on yourself while watching Netflix on the couch doesn't mean it's a casual treatment.
"This is a prescription device," Howard Sobel, a New York City dermatologist, told Allure in June. "You need to be under the care of a physician to obtain it," not to mention you need to be willing to spend nearly $1,000 on it. In addition to using for 20 minutes, three times a week, Sobel also says standard protocol calls for additional in-office light treatments.
3. Coal Tar
"Coal tar has been used for decades to treat psoriasis because of its anti-inflammatory effects," says Zeichner, who explains it's most commonly used to treat scalp psoriasis. You can usually find it in the form of a shampoo, like Neutrogena T/Gel Therapeutic Shampoo.
"Apply it to the scalp, rub it in with your fingers, and let it sit while you sing the alphabet before rinsing out," he says. "Even though it is called a shampoo, I think of it more as a scalp treatment — it must have adequate contact time on the scalp for it to do its job."
It may seem obvious, but many people with psoriasis overlook body lotion as a way to calm their skin. Light, moisturizing formulas are a great way to cover large surface areas of skin without wearing it down, says Zeichner.
"Psoriasis plaques can become dry, itchy, and flaky, which is, at the same time, uncomfortable and potentially embarrassing for patients," he says. "Moisturizers are a mainstay of treatment and can help form a protective seal over the skin to enhance hydration, reduce itch, and improve its appearance." Try a lotion like Vaseline Intensive Care Essential Healing Lotion that contains oat extract to calm inflammation and protect the skin.
You may also want to consider a moisturizer that contains alpha-hydroxy or beta-hydroxy acids. "Exfoliating moisturizers can help to remove some of the thick scale," Shainhouse has told Allure.
Zeichner recommends looking for one with go-to acne ingredient, salicylic acid, like CeraVe SA Body Lotion for Rough & Bumpy Skin, because it can help exfoliate away excess scale from psoriatic skin.
No matter which of these options sounds ideal for you, it's best to check with your dermatologist before making any sudden or significant changes to your psoriasis treatment. "If you have been using topical steroids for extended periods of time, visit your dermatologist to discuss the best way to discontinue," Zeichner advises. "This may mean a gradual process where you use the products less and less rather than stopping cold turkey."
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